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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
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of the data come from the more recent year, and hospices should still be able to see their scores change as their performance improves.
Final Decision: We are finalizing as proposed our proposals to use 90-day run-off data to calculate claims-based measures, to update claims-based measure scores annually, and to use eight quarters of data to report HVLDL
and HCI.
3. Publicly Report the Hospice Care Index and Hospice Visits in the Last Days of Life Claims-Based Measures As discussed previously, we are finalizing our proposal to publicly report the HCI and HVLDL using 2
years, which is 8 quarters of Medicare claims data. We will publicly report the HCI and HVLDL beginning no earlier than May 2022, and to include it in the Preview Reports no sooner than the May 2022 refresh. The publicly-reported version of HCI on Care Compare will only include the final HCI score, and not the component indicators. The Preview Reports will reflect the HCI as publicly reported.
We solicited public comment on this proposal for HCI and HVLDL public reporting on Care Compare no sooner than May 2022. A summary of the comments we received on this proposal and our responses to those comments appear below:
Comment: Many commenters requested clarification on the reporting period for initial reporting. They also requested clarification on the logistics of the reporting processin particular, when specifications would be available.
Response: We appreciate the opportunity to provide clarification. If released in May 2022 using eight quarters of data, the HCI and HVLDL
measure reporting period would begin with FY2021 Q1, Q2, and Q3 2021 and Q4 2020. The next four quarters would be Q3 2020 and Q2, Q3, and Q4 of 2019that is, past quarters adding up to eight quarters but omitting Q1 and Q2
of 2020, which were exempt from quality reporting please see section 10.b.2 above, Update on Use of Q4
2019 Data and Data Freeze for Refreshes in 2021. As provided in sections III
F3. Addition of a claims-based index measure, the Hospice Care Index and III F4. Update on the Hospice Visits in the Last Days of Life HVLDL and Hospice Item Set V3.00, we gave sufficient information in the proposed rule and this final rule to calculate HCI and HVLDL and access specifications. The HQRP will post a revised QM Users Manual that contains HCI and HVLDL no later than October 1, 2021 at: https www.cms.gov/

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Medicare/Quality-Initiatives-PatientAssessment-Instruments/HospiceQuality-Reporting/Current-Measures.
Comment: We received several comments expressing concern about the timing for publicly reporting HVLDL
and HCI on Care Compare and the Provider Data Catalogue. Commenters requested sufficient time to understand the measures, set up monitoring systems sometimes with vendor support, assess trends in their performance relative to national benchmarks, and develop plans for quality improvement, as CMS
normally provides. One noted that this time is needed in particular because visits on claims have not previously impacted hospice quality scores or payment. Others noted that the delay could allow time for additional analysis of the measure, and for more transparency about the rationale for it.
Many of these commenters requested that CMS wait a year until 2023 to publicly report the measures, while also requesting to confidential reports with the claims-based measures as soon as possible. One commenter requested a minimum of 6 months from the date final specifications are available for EMR and other vendors to respond to any changes in the HQRP.
Response: As stated in section III
F3e. Form, Manner and Timing of Data Collection and Submission, we have provided and will consolidate in the Users Manual specifications for HCI
and HVLDL in time to meet commenters stated needs. In addition, we will provide hospices with confidential reporting of their HVLDL
and HCI measure scores in the AgencyLevel QM report after this rule is finalizedafter August 2021. This would allow sufficient time to complete the activities related, which is what we normally aim to give providers to understand and prepare for public reporting of a new measure, if we publicly report in May 2022. We believe that the QM report and Provider Preview report will provide an indication on how well the hospice is performing as well as opportunities to provide CMS feedback on technical issues with the measures. To further support the hospice community, we will also provide education, training, and additional opportunities for hospices to receive information about the measures through open door forums or other venues.
Although these measures represent the first time that hospices are held accountable for visits information in claims, the measures reflect ideas about best practice and compliance that hospices have already known. While we are committed to provide time for
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understanding and preparation, we are not committed to ensuring that all hospices achieve high scores on the new measures before publicly reporting them. For these reasons, we believe that no additional dry run period is warranted.
Comment: A commenter suggested that CMS should not use claims data from a time period before a measure is finalized through rulemaking.
Response: Our practice across all PAC
settings has been to allow the use of claims data originating from before the finalization of a proposal to adopt a claims-based measure. For example, for the Home Health QRP, we finalized the Potentially Preventable 30-Day PostDischarge Readmission Measure in the CY 2017 Home Health QRP Rule 81 FR
76770 through 76775 for reporting with three consecutive years of claims data beginning with the CY 2018 Home Health QRP.
Comment: Commenters recommended using simple language to describe HVLDL on Care Compare, to ensure that the average consumer will understand it. For HVLDL, one commenter suggested that CMS notify consumers that the measure does not capture visits from chaplains, volunteers, hospice aides, and complementary therapies, among others. For HCI, several commenters expressed concern about CMSs ability to help consumers interpret it in a way that helps support informed decision-making. For example, an average consumer might misinterpret higher scores for live discharges or avoidance of general inpatient care as favorable.
Response: We also believe in the importance of using simple language on Care Compare to ensure consumers can easily use and appropriately interpret quality information that we provide for their decision-making. As with any measure included in the HQRP, we are committed to providing all users with the necessary information to understand the intent and application of measures in the HQRP. Before we publicly report this measure, we will provide resources to aid the public in interpreting publicly displayed quality data. For HVLDL
specifically, we will list the multidisciplinary team member visits that are included in the measure as part of the measure description displayed on Care Compare.
For the public display of HCI, our measure development contractor convened two small caregiver workgroups to gather impressions and input on the value of HCI for consumers. The caregivers were generally receptive and positive about the HCI as an additional measure for the
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